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Woodley FW, Di Lorenzo C, Sanchez R. Ambulatory Impedance-pH Assessment Is the Industry Standard But Is It Always the Best Choice? J Neurogastroenterol Motil 2024; 30:251-252. [PMID: 38576374 PMCID: PMC10999839 DOI: 10.5056/jnm23190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Affiliation(s)
- Frederick W Woodley
- Center for Motility Disorders, Nationwide Children's Hospital, Columbus, OH, USA
- Division of Gastroenterology, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Carlo Di Lorenzo
- Center for Motility Disorders, Nationwide Children's Hospital, Columbus, OH, USA
- Division of Gastroenterology, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Raul Sanchez
- Center for Motility Disorders, Nationwide Children's Hospital, Columbus, OH, USA
- Division of Gastroenterology, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
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Woodley FW. Editing Multichannel Intraluminal Impedance-pH Tracings to Reduce Non-reflux-related Esophageal Acidification. J Neurogastroenterol Motil 2024; 30:121-122. [PMID: 38173165 PMCID: PMC10774796 DOI: 10.5056/jnm23164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Affiliation(s)
- Frederick W Woodley
- Center for Neurogastroenterology and Motility Disorders, Nationwide Children's Hospital, Columbus, OH, USA
- Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
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Woodley FW. Tagging an Air Swallow From the Bottom→Up Is More Efficient Than From the Top→Down. J Neurogastroenterol Motil 2024; 30:119-120. [PMID: 38173164 PMCID: PMC10774803 DOI: 10.5056/jnm23163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Affiliation(s)
- Frederick W Woodley
- Center for Neurogastroenterology and Motility Disorders, Nationwide Children's Hospital, Columbus, OH, USA
- Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
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Woodley FW, Williams K, Di Lorenzo C, Michel HK. Significant Temporal Association of Esophageal Air Events (Supragastric Belches, Air Swallows, and Gastric Belches) With Hiccups: A Case Study in an Adolescent. JPGN Rep 2022; 3:e209. [PMID: 37168628 PMCID: PMC10158523 DOI: 10.1097/pg9.0000000000000209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 04/11/2022] [Indexed: 05/13/2023]
Abstract
We previously reported our ability to objectively assess the strength of temporal relationships between gastroesophageal reflux (GER) disease-like symptoms with esophageal air events (EAEs) (air swallows, gastric belching, and supragastric belching) using impedance-pH monitoring. Recently, we similarly evaluated an adolescent female who presented to our clinic with symptoms of recurrent hiccups and with what appeared to be numerous EAEs. Hiccups were associated with GER (symptom association probability [SAP] = 100%), air swallows (SAP = 99.7%), supragastric belches (SAP = 100%), and gastric belches (SAP = 100%), with almost twice as many of the supragastric belches preceding a hiccup than any of the other 3 esophageal disturbance types (EDs) (P < 0.00001). Our data showing a significant temporal association between EAEs and hiccups support a previous report in which belching was suspected of being associated with hiccups in an adult male. Reports such as this underscore the importance of considering the assessment of temporal relationships between extra-esophageal symptoms and EDs that include not only GER, but also EAEs, such as air swallows, gastric belches and supragastric belches, when devising strategies for clinical management of patients with hiccups.
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Affiliation(s)
- Frederick W. Woodley
- From the Center for Motility Disorders, Nationwide Children’s Hospital, Columbus, OH
- Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children’s Hospital, Columbus, OH
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
| | - Kent Williams
- From the Center for Motility Disorders, Nationwide Children’s Hospital, Columbus, OH
- Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children’s Hospital, Columbus, OH
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
| | - Carlo Di Lorenzo
- From the Center for Motility Disorders, Nationwide Children’s Hospital, Columbus, OH
- Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children’s Hospital, Columbus, OH
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
| | - Hilary K. Michel
- Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children’s Hospital, Columbus, OH
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
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Baaleman DF, Vriesman MH, Koppen IJN, Osborne KM, Benninga MA, Saps M, Yacob D, Lu PL, Woodley FW, Lorenzo CD. Hypnosis to Reduce Distress in Children Undergoing Anorectal Manometry: A Randomized Controlled Pilot Trial. J Neurogastroenterol Motil 2022; 28:312-319. [PMID: 35362456 PMCID: PMC8978122 DOI: 10.5056/jnm20274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 06/10/2021] [Accepted: 07/02/2021] [Indexed: 11/20/2022] Open
Abstract
Background/Aims To assess the effectiveness and feasibility of a brief session of hypnosis to reduce distress in children with functional constipation undergoing anorectal manometry (ARM). Methods A partially-blinded randomized controlled pilot trial was conducted in children 4-18 years old scheduled for ARM. Children were randomized to receive a brief session of hypnosis prior to ARM or standard care. Non-blinded and blinded observers rated the child's level of distress using the Observation Scale of Behavioral Distress and a 4-point-Likert scale, respectively. Differences between groups were analyzed using Fisher's exact test or Mann-Whitney U test as appropriate. Results Data from 32 children (15 hypnosis and 17 standard care) were analyzed. Prior to insertion of the catheter, the observed mean levels of distress were lower in the hypnosis group according to both the non-blinded observer (median 0.0 [interquartile range {IQR} 0.0-0.3] vs 1.4 [IQR 0.3-2.4]; P = 0.009) and the blinded observer (median 0.0 [IQR 0.0-0.0] vs 0.5 [IQR 0.0-1.0]; P = 0.044). During ARM, observed and reported levels of distress did not differ significantly. In the hypnosis group, 92.9% of parents and children reported that hypnosis helped the child to relax. There were no significant differences in resting pressure, squeeze pressure, or duration of the procedure between both groups. Conclusion A brief session of hypnosis for children before ARM is an easily incorporable intervention that lowers distress levels prior to the procedure and is positively perceived by children and parents.
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Affiliation(s)
- Desiree F Baaleman
- Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands.,Amsterdam UMC, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam, The Netherlands
| | - Mana H Vriesman
- Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ilan J N Koppen
- Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
| | - Kim M Osborne
- Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA
| | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands.,Amsterdam UMC, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam, The Netherlands
| | - Miguel Saps
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Miller School of Medicine, University of Miami, FL, USA
| | - Desale Yacob
- Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA
| | - Peter L Lu
- Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA
| | - Frederick W Woodley
- Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA
| | - Carlo Di Lorenzo
- Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA
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Affiliation(s)
- Frederick W Woodley
- Center for Motility Disorders, Nationwide Children's Hospital, Columbus, OH, USA.,Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
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Woodley FW. Superimposed Non-acid Reflux Event: An Example of When It May Be Important to Revisit the Impedance Analysis Guidelines. J Neurogastroenterol Motil 2022; 28:165-166. [PMID: 34980702 PMCID: PMC8748847 DOI: 10.5056/jnm21172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Frederick W Woodley
- Center for Motility Disorders, Nationwide Children's Hospital, Columbus, OH, USA.,Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
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Woodley FW, Gecili E, Szczesniak RD, Shrestha CL, Nemastil CJ, Kopp BT, Hayes D. Sweat metabolomics before and after intravenous antibiotics for pulmonary exacerbation in people with cystic fibrosis. Respir Med 2022; 191:106687. [PMID: 34864373 PMCID: PMC8810598 DOI: 10.1016/j.rmed.2021.106687] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/06/2021] [Accepted: 11/20/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND People with cystic fibrosis (PWCF) suffer from acute unpredictable reductions in pulmonary function associated with a pulmonary exacerbation (PEx) that may require hospitalization. PEx symptoms vary between PWCF without universal diagnostic criteria for diagnosis and response to treatment. RESEARCH QUESTION We characterized sweat metabolomes before and after intravenous (IV) antibiotics in PWCF hospitalized for PEx to determine feasibility and define biological alterations by IV antibiotics for PEx. STUDY DESIGN AND METHODS PWCF with PEx requiring hospitalization for IV antibiotics were recruited from clinic. Sweat samples were collected using the Macroduct® Sweat Collection System at admission prior to initiation of IV antibiotics and after completion prior to discharge. Samples were analyzed for metabolite changes using ultra-high-performance liquid chromatography/tandem accurate mass spectrometry. RESULTS Twenty-six of 29 hospitalized PWCF completed the entire study. A total of 326 compounds of known identity were detected in sweat samples. Of detected metabolites, 147 were significantly different between pre-initiation and post-completion of IV antibiotics for PEx (average treatment 14 days). Global sweat metabolomes changed from before and after IV antibiotic treatment. We discovered specific metabolite profiles predictive of PEx status as well as enriched biologic pathways associated with PEx. However, metabolomic changes were similar in PWCF who failed to return to baseline pulmonary function and those who did not. INTERPRETATION Our findings demonstrate the feasibility of non-invasive sweat metabolomic profiling in PWCF and the potential for sweat metabolomics as a prospective diagnostic and research tool to further advance our understanding of PEx in PWCF.
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Affiliation(s)
- Frederick W. Woodley
- Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children’s Hospital and The Ohio State University College of Medicine, Columbus, OH, USA
| | - Emrah Gecili
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Rhonda D. Szczesniak
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA,Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Chandra L. Shrestha
- Center for Microbial Pathogenesis, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | - Christopher J. Nemastil
- Division of Pulmonary Medicine, Nationwide Children’s Hospital and The Ohio State University College of Medicine, Columbus, OH, USA
| | - Benjamin T. Kopp
- Division of Pulmonary Medicine, Nationwide Children’s Hospital and The Ohio State University College of Medicine, Columbus, OH, USA,Center for Microbial Pathogenesis, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | - Don Hayes
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Woodley FW, Hayes D, Kopp BT, Moore-Clingenpeel M, Machado RS, Nemastil CJ, Jadcherla S, Di Lorenzo C, Kaul A, Mousa H. Gastroesophageal reflux in cystic fibrosis across the age spectrum. Transl Gastroenterol Hepatol 2019; 4:69. [PMID: 31620651 DOI: 10.21037/tgh.2019.08.11] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 08/13/2019] [Indexed: 02/06/2023] Open
Abstract
Background Scientific advances have improved longevity in cystic fibrosis (CF) patients and many of these patients can expect to experience age-related gastrointestinal co-morbidities. We aimed to assess the extent to which age might impact gastroesophageal reflux (GER) in patients with CF. Methods Our esophageal pH-multichannel intraluminal impedance monitoring database was searched for tracings belonging to CF patients ≥2 years old without prior fundoplication and not taking anti-reflux medications immediately prior (within 7 days) and during the study. Tracings were retrospectively analyzed; Impedance and pH variables were evaluated with respect to age and pulmonary function. Results Twenty-eight patients were enrolled; 16 children (3.1-17.7 years) and 12 adults (18.2-48.9 years). Among pH probe parameters, correlation analysis showed DeMeester score (P=0.011) and number of acid reflux events lasting >5 minutes (P=0.047) to be significantly correlated with age. Age was not significantly correlated with any of the impedance parameters. Age was negatively correlated with baseline impedance (BI) in the distal esophagus (r=-0.424, P=0.023) and BI was negatively correlated with several pH parameters, including reflux index (r=-0.553, P=0.002), number of total acid reflux events (r=-0.576, P=0.001), number of acid reflux events lasting >5 minutes (r=-0.534, P=0.003), and DeMeester score (r=-0.510, P=0.006). Pulmonary function (percent predicted forced expiratory volume in one minute; ppFEV1) was negatively correlated with age (r=-0.494, P=0.0007). The interaction of age and ppFEV1 and any of the reflux parameters, however, was not significant (P>0.05); the strongest evidence for an interaction was found for the number of acid reflux events reaching the proximal esophagus, but this interaction still did not reach statistical significance (P=0.070). Conclusions In a small cohort, we found evidence that age may be associated with increased acid exposure and that both age and increased acid exposure are associated with reduced BI in the distal esophagus. The negative relationship between pulmonary function and age in our cohort is not related to GER. This pilot study supports the need for esophageal assessment and treatment of GER as standard components of clinical care for an aging CF population.
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Affiliation(s)
- Frederick W Woodley
- Center for Motility Disorders, Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Don Hayes
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Division of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Benjamin T Kopp
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Division of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | | | | | | | - Sudarshan Jadcherla
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Carlo Di Lorenzo
- Center for Motility Disorders, Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Ajay Kaul
- Division of Gastroenterology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Hayat Mousa
- Division of Gastroenterology, Rady Children's Hospital, San Diego, CA, USA.,Department of Pediatrics, University of California-San Diego, San Diego, CA, USA
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Woodley FW. Gastroesophageal Reflux Events Occurring During a Meal Can Still Be Temporally Associated With a Symptom Even When Analysis Settings Are Set to Exclude Meals. J Neurogastroenterol Motil 2019; 25:471-472. [PMID: 31177648 PMCID: PMC6657927 DOI: 10.5056/jnm19020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Frederick W Woodley
- Motility Center, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Kopp BT, Thompson R, Kim J, Konstan R, Diaz A, Smith B, Shrestha C, Rogers LK, Hayes D, Tumin D, Woodley FW, Ramilo O, Sanders DB, Groner JA, Mejias A. Secondhand smoke alters arachidonic acid metabolism and inflammation in infants and children with cystic fibrosis. Thorax 2019; 74:237-246. [PMID: 30661024 DOI: 10.1136/thoraxjnl-2018-211845] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 11/09/2018] [Accepted: 12/24/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND Mechanisms that facilitate early infection and inflammation in cystic fibrosis (CF) are unclear. We previously demonstrated that children with CF and parental-reported secondhand smoke exposure (SHSe) have increased susceptibility to bacterial infections. SHSe hinders arachidonic acid (AA) metabolites that mediate immune function in patients without CF, and may influence CF immune dysfunction. We aimed to define SHSe's impact on inflammation mediators and infection in children with CF. METHODS Seventy-seven children with CF <10 years of age (35 infants <1 year; 42 children 1-10 years) were enrolled and hair nicotine concentrations measured as an objective surrogate of SHSe. AA signalling by serum and macrophage lipidomics, inflammation using blood transcriptional profiles and in vitro macrophage responses to bacterial infection after SHSe were assessed. RESULTS Hair nicotine concentrations were elevated in 63% of patients. Of the AA metabolites measured by plasma lipidomics, prostaglandin D2 (PGD2) concentrations were decreased in children with CF exposed to SHSe, and associated with more frequent hospitalisations (p=0.007) and worsened weight z scores (p=0.008). Children with CF exposed to SHSe demonstrated decreased expression of the prostaglandin genes PTGES3 and PTGR2 and overexpression of inflammatory pathways. These findings were confirmed using an in vitro model, where SHSe was associated with a dose-dependent decrease in PGD2 and increased methicillin-resistant Staphylococcus aureus survival in human CF macrophages. CONCLUSIONS Infants and young children with CF and SHSe have altered AA metabolism and dysregulated inflammatory gene expression resulting in impaired bacterial clearance. Our findings identified potential therapeutic targets to halt early disease progression associated with SHSe in the young population with CF.
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Affiliation(s)
- Benjamin T Kopp
- Division of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.,Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Rohan Thompson
- Division of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Jeeho Kim
- Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Robert Konstan
- Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Alejandro Diaz
- Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Bennett Smith
- Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Chandra Shrestha
- Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Lynette K Rogers
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Don Hayes
- Division of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Dmitry Tumin
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Frederick W Woodley
- Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Octavio Ramilo
- Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Don B Sanders
- Riley Children's Hospital, Indianapolis, Indiana, USA
| | - Judith A Groner
- Section of Ambulatory Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Asuncion Mejias
- Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
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Abstract
Gastroesophageal reflux (GER) is the retrograde movement of gastric (and sometimes duodenal) contents into the esophagus. While the majority of GER is physiologic, for patients, it can be associated with symptoms. While some symptoms are merely bothersome (crying), others can be life threatening (cough, gagging, choking). The main driver of GER in infants is the frequent feedings that produce increased intra-abdominal pressure, which is known to trigger transient relaxations of the lower esophageal sphincter. The recent 2018 clinical practice guidelines reported by the North American and European Societies for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN/ESPGHAN) have recommended non-pharmacologic management initially with subsequent consideration of brief trials with acid suppressants. The main target for these acid suppressants is the gastric parietal cells. Our review of the literature has revealed a paucity of data regarding the use of histamine-2 receptor antagonists and proton pump inhibitors in infants. Despite the absence of well-controlled clinical studies, the prescription rate of these medications has increased internationally. Risks to patients of all ages have become increasingly recognized, with new associations being reported all too often. Here we report our review of all pharmacologic modalities as well as some non-surgical options.
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Affiliation(s)
- Steven L Ciciora
- Division of Gastroenterology, Hepatology and Nutrition, Center for Functional Motility Disorders, Nationwide Children's Hospital, Columbus, OH, 43205, USA.,Department of Pediatrics, The Ohio State University College of Medicine, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Frederick W Woodley
- Division of Gastroenterology, Hepatology and Nutrition, Center for Functional Motility Disorders, Nationwide Children's Hospital, Columbus, OH, 43205, USA. .,Department of Pediatrics, The Ohio State University College of Medicine, 700 Children's Drive, Columbus, OH, 43205, USA.
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13
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Kopp BT, McCulloch S, Shrestha CL, Zhang S, Sarzynski L, Woodley FW, Hayes D. Metabolomic responses to lumacaftor/ivacaftor in cystic fibrosis. Pediatr Pulmonol 2018; 53:583-591. [PMID: 29461009 DOI: 10.1002/ppul.23972] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 01/30/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Cystic fibrosis (CF) is a life-limiting disease caused by a defect in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Lumacaftor/Ivacaftor is a novel CFTR modulator approved for patients that are homozygous for Phe508del CFTR, but its clinical effectiveness varies amongst patients, making it difficult to determine clinical responders. Therefore, identifying biochemical biomarkers associated with drug response are clinically important for follow-up studies. METHODS Serum metabolomics was performed on twenty patients with CF pre- and 6-month post-Lumacaftor/Ivacaftor response via Ultrahigh Performance Liquid Chromatography-Tandem Mass Spectroscopy (UPLC-MS/MS). Correlation with clinical variables was performed. RESULTS Metabolomics analysis demonstrated 188 differentially regulated metabolites between patients pre- and post-Lumacaftor/Ivacaftor initiation, with a predominance of lipid and amino acid alterations. The top 30 metabolites were able to differentiate pre- and post-Lumacaftor/Ivacaftor status in greater than 90% of patients via a random-forest confusion matrix. Alterations in bile acids, phospholipids, and bacteria-associated metabolites were the predominant changes associated with drug response. Importantly, changes in metabolic patterns were associated with clinical responders. CONCLUSIONS Selected key lipid and amino acid metabolic pathways were significantly affected by Lumacaftor/Ivacaftor initiation and similar pathways were affected in clinical responders. Targeted metabolomics may provide useful and relevant biomarkers of CFTR modulator responses.
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Affiliation(s)
- Benjamin T Kopp
- Department of Pediatrics, The Ohio State University College of Medicine Columbus, Columbus, Ohio.,Division of Pulmonary Medicine, Nationwide Children's Hospital Columbus, Columbus, Ohio.,Center for Microbial Pathogenesis, Nationwide Children's Hospital Columbus, Columbus, Ohio
| | | | - Chandra L Shrestha
- Center for Microbial Pathogenesis, Nationwide Children's Hospital Columbus, Columbus, Ohio
| | - Shuzhong Zhang
- Center for Microbial Pathogenesis, Nationwide Children's Hospital Columbus, Columbus, Ohio
| | - Lisa Sarzynski
- Department of Pediatrics, The Ohio State University College of Medicine Columbus, Columbus, Ohio.,Division of Pulmonary Medicine, Nationwide Children's Hospital Columbus, Columbus, Ohio
| | - Frederick W Woodley
- Department of Pediatrics, The Ohio State University College of Medicine Columbus, Columbus, Ohio.,Division of Gastroenterology, Nationwide Children's Hospital Columbus, Columbus, Ohio
| | - Don Hayes
- Department of Pediatrics, The Ohio State University College of Medicine Columbus, Columbus, Ohio.,Division of Pulmonary Medicine, Nationwide Children's Hospital Columbus, Columbus, Ohio.,Department of Internal Medicine, The Ohio State University College of Medicine Columbus, Columbus, Ohio
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Woodley FW. A Positive Reflux-Symptom Association Is Not Marked When the Onset of the Reflux Episode Does Not Occur Within the Pre-symptom Time Window. J Neurogastroenterol Motil 2018; 24:324-325. [PMID: 29605987 PMCID: PMC5885732 DOI: 10.5056/jnm18015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Frederick W Woodley
- Motility Center, Nationwide Children's Hospital, Columbus, Ohio, USA.,Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
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15
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Woodley FW, Moore-Clingenpeel M, Machado RS, Nemastil CJ, Jadcherla SR, Hayes D, Kopp BT, Kaul A, Di Lorenzo C, Mousa H. Not All Children with Cystic Fibrosis Have Abnormal Esophageal Neutralization during Chemical Clearance of Acid Reflux. Pediatr Gastroenterol Hepatol Nutr 2017; 20:153-159. [PMID: 29026731 PMCID: PMC5636931 DOI: 10.5223/pghn.2017.20.3.153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 07/12/2017] [Accepted: 07/15/2017] [Indexed: 01/25/2023] Open
Abstract
PURPOSE Acid neutralization during chemical clearance is significantly prolonged in children with cystic fibrosis, compared to symptomatic children without cystic fibrosis. The absence of available reference values impeded identification of abnormal findings within individual patients with and without cystic fibrosis. The present study aimed to test the hypothesis that significantly more children with cystic fibrosis have acid neutralization durations during chemical clearance that fall outside the physiological range. METHODS Published reference value for acid neutralization duration during chemical clearance (determined using combined impedance/pH monitoring) was used to assess esophageal acid neutralization efficiency during chemical clearance in 16 children with cystic fibrosis (3 to <18 years) and 16 age-matched children without cystic fibrosis. RESULTS Duration of acid neutralization during chemical clearance exceeded the upper end of the physiological range in 9 of 16 (56.3%) children with and in 3 of 16 (18.8%) children without cystic fibrosis (p=0.0412). The likelihood ratio for duration indicated that children with cystic fibrosis are 2.1-times more likely to have abnormal acid neutralization during chemical clearance, and children with abnormal acid neutralization during chemical clearance are 1.5-times more likely to have cystic fibrosis. CONCLUSION Significantly more (but not all) children with cystic fibrosis have abnormally prolonged esophageal clearance of acid. Children with cystic fibrosis are more likely to have abnormal acid neutralization during chemical clearance. Additional studies involving larger sample sizes are needed to address the importance of genotype, esophageal motility, composition and volume of saliva, and gastric acidity on acid neutralization efficiency in cystic fibrosis children.
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Affiliation(s)
- Frederick W Woodley
- Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | | | | | | | - Sudarshan R Jadcherla
- Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Research Institute and Neonatology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Don Hayes
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Division of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Benjamin T Kopp
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Division of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Ajay Kaul
- Division of Gastroenterology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, OSU University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Carlo Di Lorenzo
- Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Hayat Mousa
- Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA.,Division of Gastroenterology, Rady Children's Hospital, San Diego, CA, USA.,Department of Pediatrics, The University of California at San Diego College of Medicine, San Diego, CA, USA
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16
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Black SM, Woodley FW, Tumin D, Mumtaz K, Whitson BA, Tobias JD, Hayes D. Cystic Fibrosis Associated with Worse Survival After Liver Transplantation. Dig Dis Sci 2016; 61:1178-85. [PMID: 26602912 DOI: 10.1007/s10620-015-3968-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 11/08/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND Survival in cystic fibrosis patients after liver transplantation and liver-lung transplantation is not well studied. AIMS To discern survival rates after liver transplantation and liver-lung transplantation in patients with and without cystic fibrosis. METHODS The United Network for Organ Sharing database was queried from 1987 to 2013. Univariate Cox proportional hazards, multivariate Cox models, and propensity score matching were performed. RESULTS Liver transplant and liver-lung transplant were performed in 212 and 53 patients with cystic fibrosis, respectively. Univariate Cox proportional hazards regression identified lower survival in cystic fibrosis after liver transplant compared to a reference non-cystic fibrosis liver transplant cohort (HR 1.248; 95 % CI 1.012, 1.541; p = 0.039). Supplementary analysis found graft survival was similar across the 3 recipient categories (log-rank test: χ(2) 2.68; p = 0.262). Multivariate Cox models identified increased mortality hazard among cystic fibrosis patients undergoing liver transplantation (HR 2.439; 95 % CI 1.709, 3.482; p < 0.001) and liver-lung transplantation (HR 2.753; 95 % CI 1.560, 4.861; p < 0.001). Propensity score matching of cystic fibrosis patients undergoing liver transplantation to non-cystic fibrosis controls identified a greater mortality hazard in the cystic fibrosis cohort using a Cox proportional hazards model stratified on matched pairs (HR 3.167; 95 % CI 1.265, 7.929, p = 0.014). CONCLUSIONS Liver transplantation in cystic fibrosis is associated with poorer long-term patient survival compared to non-cystic fibrosis patients, although the difference is not due to graft survival.
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Affiliation(s)
- Sylvester M Black
- Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA.,Center for Epidemiology of Organ Failure and Transplantation, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Frederick W Woodley
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Center for Epidemiology of Organ Failure and Transplantation, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH, 43205, USA.,Section of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, 43205, USA
| | - Dmitry Tumin
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Center for Epidemiology of Organ Failure and Transplantation, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH, 43205, USA.,Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Khalid Mumtaz
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA.,Center for Epidemiology of Organ Failure and Transplantation, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Bryan A Whitson
- Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA.,Center for Epidemiology of Organ Failure and Transplantation, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Joseph D Tobias
- Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, OH, USA.,Center for Epidemiology of Organ Failure and Transplantation, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH, 43205, USA.,Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Don Hayes
- Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA. .,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA. .,Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA. .,Center for Epidemiology of Organ Failure and Transplantation, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH, 43205, USA. .,Section of Pulmonary Medicine, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, 43205, USA.
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17
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Machado RS, Woodley FW, Skaggs B, Di Lorenzo C, Eneli I, Splaingard M, Mousa H. Gastroesophageal Reflux Affects Sleep Quality in Snoring Obese Children. Pediatr Gastroenterol Hepatol Nutr 2016; 19:12-9. [PMID: 27066445 PMCID: PMC4821978 DOI: 10.5223/pghn.2016.19.1.12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 11/21/2015] [Accepted: 11/28/2015] [Indexed: 12/13/2022] Open
Abstract
PURPOSE This study was performed to evaluate the quality of sleep in snoring obese children without obstructive sleep apnea (OSA); and to study the possible relationship between sleep interruption and gastroesophageal reflux (GER) in snoring obese children. METHODS Study subjects included 13 snoring obese children who were referred to our sleep lab for possible sleep-disordered breathing. Patients underwent multichannel intraluminal impedance and esophageal pH monitoring with simultaneous polysomnography. Exclusion criteria included history of fundoplication, cystic fibrosis, and infants under the age of 2 years. Significant association between arousals and awakenings with previous reflux were defined by symptom-association probability using 2-minute intervals. RESULTS Sleep efficiency ranged from 67-97% (median 81%). A total of 111 reflux episodes (90% acidic) were detected during sleep, but there were more episodes per hour during awake periods after sleep onset than during sleep (median 2.3 vs. 0.6, p=0.04). There were 279 total awakenings during the sleep study; 56 (20.1%) of them in 9 patients (69.2%) were preceded by reflux episodes (55 acid, 1 non-acid). In 5 patients (38.5%), awakenings were significantly associated with reflux. CONCLUSION The data suggest that acid GER causes sleep interruptions in obese children who have symptoms of snoring or restless sleep and without evidence of OSA.
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Affiliation(s)
- Rodrigo Strehl Machado
- Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Frederick W Woodley
- Division of Pediatric Gastroenterology, Ohio State University, Columbus, OH, USA
| | - Beth Skaggs
- Department of Pediatrics,Nationwide Children's Hospital, Columbus, OH, USA
| | - Carlo Di Lorenzo
- Division of Pediatric Gastroenterology, Ohio State University, Columbus, OH, USA
| | - Ihuoma Eneli
- Department of Pediatrics, Ohio State University, Columbus, OH, USA
| | - Mark Splaingard
- Department of Pediatrics, Ohio State University, Columbus, OH, USA
| | - Hayat Mousa
- Division of Pediatric Gastroenterology, Ohio State University, Columbus, OH, USA
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18
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Woodley FW, Machado RS, Hayes D, Di Lorenzo C, Kaul A, Skaggs B, McCoy K, Patel A, Mousa H. Children with cystic fibrosis have prolonged chemical clearance of acid reflux compared to symptomatic children without cystic fibrosis. Dig Dis Sci 2014; 59:623-30. [PMID: 24287640 DOI: 10.1007/s10620-013-2950-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 11/11/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Few studies compare gastroesophageal reflux (GER) parameters of cystic fibrosis (CF) children and symptomatic non-CF children. We aimed to compare the impedance-pH (IMP-pH) parameters for these two groups and to test the hypothesis that prolonged acid exposure in CF patients is due to delayed chemical clearance (CC). METHODS IMP-pH tracings from 16 CF children (median 8.2 years) and 16 symptomatic non-CF children (median 8.3 years) were analyzed. Software was used to generate IMP-pH reports and parameter data were extracted. IMP-pH was used to calculate the mean CC for each patient. RESULTS pH studies showed no difference in acid GER (AGER) frequency (p = 0.587); however, mean AGER duration, duration of longest AGER, AGER index, and DeMeester scores were all significantly higher for CF patients. IMP showed no difference in GER frequency [neither acidic (p = 0.918) nor non-acidic (p = 0.277)], but total bolus clearance was more efficient in CF patients (p = 0.049). A larger percentage of total GER reached the proximal esophagus in non-CF children (p = 0.039). Analyses of two-phase AGER episodes showed that these events were more acidic (p = 0.003) and the CC phase was significantly prolonged in the CF cohort (p = 0.001). CONCLUSIONS Compared to symptomatic non-CF children, CF children do not have more frequent reflux. Actually, they have better bolus clearance efficiency following reflux and may even have better control over the number of GER episodes that reach the proximal esophagus. CC of AGER, however, is significantly prolonged in the CF cohort, likely due to hyperacidity of refluxed gastric contents.
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Affiliation(s)
- Frederick W Woodley
- Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA,
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19
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Abstract
Cystic fibrosis (CF) is an inherited disease that affects both the lungs and the digestive system in children and adults. Thick mucus fills the gut and blocks lumens of the pancreas and hepatobiliary systems, creating insufficient pancreas function and liver disease. Chronic gastrointestinal (GI) complications, including intestinal obstruction, occur in neonates, and poor digestion and gastroesophageal reflux disease (GERD) in children. Although GI symptoms tend to improve with age, CF and associated GERD eventually create respiratory insufficiency; the only available treatment option at this stage is a bilateral lung transplant, which carries considerable morbidity and mortality. While GERD may reoccur as a complication of lung transplantation, GERD symptoms are often reduced following a fundoplication.
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Affiliation(s)
- Hayat M Mousa
- Center for Advanced Research in Neuromuscular Gastrointestinal Disorders, The Ohio State University, Nationwide Children's Hospital, Columbus, OH 43205, USA.
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20
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Abstract
BACKGROUND & AIMS Clearance of acid gastroesophageal reflux is biphasic. During volume clearance, refluxed material is cleared from the esophagus by peristalsis, and during chemical clearance, acidified esophageal mucosa is neutralized by saliva and possibly secretions from the esophageal lumen. In this study, we examined the effects of feeding on the durations of volume clearance and chemical clearance. METHODS Combined pH/multichannel intraluminal impedance tracings from 12 symptomatic infants (median age, 20 weeks) were analyzed. Acid gastroesophageal reflux episodes having both volume clearance and chemical clearance components were grouped into 1 of 4 feeding cycle phases (feeding, first hour postprandial, second hour postprandial, and fasting). RESULTS Mean duration of volume clearance and chemical clearance was 7.0 +/- 2.3 and 36.3 +/- 8.5 minutes (P = .001), respectively, per patient and 24.7 +/- 2.7 and 127.5 +/- 10.7 seconds (P < .0001), respectively, per episode. Whereas volume clearance did not change throughout the feeding cycle, chemical clearance was significantly prolonged during fasting (132.2 +/- 18.4 seconds) compared with feeding (13.5 +/- 4.1 seconds, P = .0046) and 1st postprandial (64.0 +/- 19.4 seconds, P = .0333). Statistical analysis failed to demonstrate a significant relationship between nadir pH and chemical clearance (P = .3104) or between chemical clearance and the interaction between nadir pH and feeding cycle. CONCLUSIONS Chemical clearance is significantly prolonged during fasting in infants. Falling pH alone cannot explain declining chemical clearance efficiency during later postprandial periods. We speculate that inefficient chemical clearance during fasting is likely due to reduced efficiency of acid clearance mechanisms that could include salivation, swallowing, peristalsis, and/or intraluminal secretion.
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Affiliation(s)
- Frederick W Woodley
- Center for Advanced Research in Neuromuscular Gastrointestinal Disorders, Columbus Children's Hospital, Columbus, Ohio 43205, USA.
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21
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Woodley FW, Mousa H. Acid gastroesophageal reflux reports in infants: a comparison of esophageal pH monitoring and multichannel intraluminal impedance measurements. Dig Dis Sci 2006; 51:1910-6. [PMID: 17053958 DOI: 10.1007/s10620-006-9179-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2005] [Accepted: 01/25/2006] [Indexed: 12/09/2022]
Abstract
Twenty-four-hour tracings generated from combined esophageal pH and multichannel intraluminal impedance measurements of 14 infants (nine males, median age 3.5 months) were examined retrospectively. For each tracing, two acid reflux assessment reports were generated using either pH monitoring alone or pH monitoring combined with impedance. Significantly fewer acid reflux episodes were detected using pH monitoring combined with impedance when compared to pH monitoring alone (25.1+/-4.0 versus 99.9+/-18.3 episodes/patient, p=.001). Estimates of esophageal acid exposure using pH monitoring alone were two-fold higher (137.4+/-23.7 versus 66.6+/-15.9 min/patient, p=.002) than estimates derived using both techniques. Of the total acid reflux episodes detected by pH monitoring alone, 71.8% could not be confirmed by combined pH and impedance. Detection of significant numbers of "pH-only" episodes raises concerns regarding possible over-estimations of acid exposure that may occur when estimates are based solely on esophageal pH monitoring.
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Affiliation(s)
- Frederick W Woodley
- Center for Advanced Research in Neuromuscular Gastroenterology, Motility Research Division, Columbus Children's Hospital, The Ohio State University College of Medicine, 700 Children's Drive, Columbus, Ohio 43205, USA.
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22
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Abstract
BACKGROUND There is controversy regarding the association between gastroesophageal reflux and apnea. The controversy is further confused by the variety of ways reflux is detected, the varying methods of data analysis and the heterogeneity of subjects studied. OBJECTIVES To determine if apnea is associated with reflux and to determine whether the association differs with acid or non acid reflux. METHODS We prospectively evaluated infants with apparent life-threatening events or apnea by simultaneous pneumography, esophageal pH and multichannel intraluminal impedance monitoring. Apneic events and reflux frequency, duration, acidity and height were recorded. Apneic events were considered to be temporally linked to gastroesophageal reflux when they occurred during a gastroesophageal reflux episode or within 5 minutes after clearance of the refluxate. Data described with frequency tables, scatterplots and time series graphs were analyzed by regression analysis and chi testing. RESULTS Twenty-five infants (10 males) aged 1 to 19 months were studied for up to 24 hours. Of 527 total apneic episodes, only 80 (15.2%) were temporally linked with gastroesophageal reflux: 37 (7.0%) with acid reflux and 43 (8.2%) with non-acid reflux. Scatterplots revealed no significant correlation between apnea and frequency or duration of reflux episodes. Individual chi analyses within subjects found limited associations between reflux and apnea. Regression analyses showed a significant association between apnea and reflux in 4 of 25 subjects. CONCLUSIONS We found little evidence for an association between apnea and total reflux, acid reflux or non-acid reflux. There was no difference between acid gastroesophageal reflux and non-acid gastroesophageal reflux in the frequency association with apnea. Either a chi statistic for each subject or R value computed from a lagged regression model for each subject can be used as an index of association in patient evaluation.
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Affiliation(s)
- Hayat Mousa
- The Center for Advanced Research in Neuromuscular Gastrointestinal Disorders (CARING), Division of Pediatric Gastroenterology, Columbus Children's Hospital, The Ohio State University School of Medicine 43205, USA.
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